Joint Subcommittee on Mental Health Transitions to New Behavioral Health Commission; Focus Remains on State Hospital Overcrowding

July 23, 2021

Discussions at the July 15 meeting of the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century took on fresh urgency as a result of the temporary closure of five state hospitals to new admissions, which was announced by Department of Behavioral Health and Developmental Services Commissioner Alison Land on July 9.  The Joint Subcommittee advanced a package of potential funding solutions for further discussion at the upcoming special session in the hope that some of the federal relief funding coming to the state through the American Rescue Plan Act (ARPA) may be able to ameliorate the census pressures at the state hospitals while work continues to build out a comprehensive, community-based system of crisis services.

Commissioner Land made a presentation to the Joint Subcommittee regarding the situation at the state hospitals and the Department’s funding requests for the special session.  As in previous presentations, she discussed the dangerous situation presented when state hospitals are frequently operating at or above 100 percent capacity, while staffing levels can be as low as 60 to 70 percent in some facilities.  Before the pandemic, state facilities had more than 1000 vacant positions; at the time her presentation was prepared, that number had increased to 1547.  The Department attributes this high rate of attrition to inadequate compensation as well as concerns that staffing shortages exacerbate, such as assaults on staff and mandatory overtime in some facilities.  In summarizing the situation, Commissioner Land told Joint Subcommittee members, “Our safety net is no longer safe.”

In the short term, the Department will use $25 million from its emergency fund to pay bonuses to hospital staff, in an effort to improve retention, and to contract for additional staff for the facilities that are temporarily closed.  However, this funding will only support the contract staffing for 13 weeks.  The Department’s priority requests for ARPA funding include $75 million to bring direct care staff salaries closer to being competitive; $6 million for additional security and safety infrastructure and contract staffing; $3 million to improve discharge planning; and $5 million to expand a pilot program to support individuals with dementia in nursing homes (and avoid state hospital admissions for these patients).

A workgroup of the Joint Subcommittee has held several meetings this spring and summer with a focus on state hospital overcrowding, including the strain on law enforcement, who at times are waiting with patients in emergency departments for days until a bed becomes available.  Legislators and advocates have also pointed to the harmful effects on patients, who may not be receiving psychiatric care while they wait and can be further traumatized by the experience.  The workgroup, chaired by Senator Monty Mason, submitted a series of recommendations, all of which the full Joint Subcommittee agreed to advance for further discussions.  The recommendations included the following proposals:

  • Funding to expand existing Crisis Intervention Team Assessment Centers (CITACs) to enable 24/7 operation.
  • Funding to expand the scope of services offered in up to five existing CITACs to establish regional receiving centers.
  • Funding for staff recruitment and retention at state hospitals.
  • Funding for private behavioral health facilities to enable opening of beds that are currently licensed but not staffed. A proposal reported in the media would allow 58 beds to open if the state provided $8.5 million to support staffing costs.
  • Funding to incentivize private facilities to accept more challenging patients.
  • Exploration of options to reduce the impact of serving the forensic population on bed availability for civil patients, to include establishment of forensic-only facilities.
  • Incentives for private hospitals to provide security necessary for law enforcement to transfer custody of an individual subject to a temporary detention order to the facility.
  • Expansion of the existing contract for alternative transportation to allow the contractor’s staff to wait with individuals subject to temporary detention orders (currently, the contract only covers transportation of these individuals).
  • Funding for overtime pay for deputies who must wait with individuals for available beds.

Several items on this list were also recommended by DBHDS, including expansion of CITACs, funding for staffing at state hospitals, and expansion of the alternative transportation contract.

July 15 was the Joint Subcommittee’s last meeting in its current form.  Legislation passed this year creates a stand-alone Behavioral Health Commission, which held its inaugural meeting later that day to elect a chair and vice-chair and begin the process of organizing the new body.  Senator Creigh Deeds was chosen as chair, with Delegate Patrick Hope selected as vice-chair.  The Commission is expected to continue its work throughout the summer with temporary support from the Division of Legislative Services while it works to hire staff.

VACo Contact:  Katie Boyle

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